Labor induction is when an external agent is employed to stimulate contractions before the onset of spontaneous labor.
Labor augmentation uses the same techniques as labor induction but uterine contractions (frequency, duration and strength) are enhanced once labor has started.
Labor induction is generally indicated when the benefits of delivery outweigh the risks of continuing the pregnancy.
Women at 42 weeks of gestation who chose not to undergo labor induction should be monitored more often with at least twice-weekly assessment of fetal well-being (cardiotocography & estimation of maximum amniotic pool depth by ultrasound).

Pharmacotherapy

Prostaglandin

Prostaglandin E2 (PGE2) [eg Dinoprostone]

Effective agent for ripening of cervix and labor induction if cervix is unfavorable

May be used as a ripening agent or for induction with premature rupture of membranes (PROM) at term except in patients with lower segment cesarean section (CS) scar due to increased risk of uterine rupture

Prostaglandin E2 (PGE2) may be preferred for labor induction in nulliparous or multiparous women with intact membranes regardless of cervical favorability

Causes disintegration of collagen bundles and increase in submucosal water content of the cervix, like those observed in early labor

Associated with increase in successful vaginal delivery within 24 hours and decrease in both CS rate and risk of cervix remaining unfavorable at 24-48 hours

Efficacy is equivalent to Oxytocin for labor induction in nulliparous or multiparous women with ruptured membranes regardless of cervical status

May be given in various routes but local administration in the vagina is the route of choice due to fewer side effects and acceptable clinical response

Intravaginal PGE2 is the preferred method of labor induction except in those at risk of uterine tachysystole

Recommended regimen is one cycle of vaginal PGE2 (tab or gel): One dose followed by a 2nd dose if labor does not ensue (if controlled pessary is used, one dose over 24 hours)

Misoprostol

A synthetic Prostaglandin E1 analog that can cause cervical ripening of an unfavorable cervix and induce uterine contractions

Can be used directly for induction of labor with a favorable cervix

Oral or vaginal route is recommended for induction of labor in women with non-scarred uterus

Considered an effective and safe drug for labor induction in patients with intact membranes

Contraindicated in women with previous cesarean section

Also used to induce labor in women with intrauterine fetal death (IUFD)

Same dose and regimen as for induction of labor at term is recommended

A tocolytic agent, ie terbutaline, must be available during labor induction

Uterine tachysystole can occur with all Misoprostol doses

Oxytocin

Mother and fetus should be carefully monitored and drug infusion accurately titrated

Intravenous (IV) Oxytocin has been widely used for induction and augmentation of labor

It induces uterine activity that is sufficient to produce cervical change and fetal descent while avoiding uterine tachysystole

If prostaglandins are unavailable, IV Oxytocin with or without a balloon catheter is appropriate

Use of Oxytocin has not been shown to be effective in ripening the cervix but is the preferred pharmacologic agent for inducing labor when the cervix is favorable or ripe

Decision to augment labor using Oxytocin is based upon clinical judgment with consideration to fetal size, presentation, position, pelvic size, and fetal condition

Dose should be titrated to prevent excessive uterine activity and to give 4-5 uterine contractions in 10 min

Amniotomy should be done when feasible prior to the start of Oxytocin infusion in women with intact membranes

Oxytocin should be considered prior expectant management in patients with ruptured membranes at term

Antiprogestogen

Oral Mifepristone is given to induce labor in women with IUFD, followed by vaginal PGE2 or Misoprostol

Patients that appear physically well and with membranes that are intact or with no signs of infection or bleeding should be given an option of immediate labor induction or expectant management

Patients with ruptured membranes or signs of infection or bleeding should undergo immediate labor induction

Mechanical Methods

Promote cervical
ripening and/or labor induction through mechanical pressure and release of
endogenous
prostaglandins from the
membranes and maternal decidua

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